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. 2013 May;36(5):1126-31.
doi: 10.2337/dc11-1969. Epub 2013 Feb 7.

Detectable Subclinical Myocardial Necrosis Is Associated With Cardiovascular Risk in Stable Patients With Diabetes

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Free PMC article

Detectable Subclinical Myocardial Necrosis Is Associated With Cardiovascular Risk in Stable Patients With Diabetes

W H Wilson Tang et al. Diabetes Care. .
Free PMC article

Abstract

Objective: To investigate the relationship between different degrees of subclinical myocardial necrosis, glycemic control, and long-term adverse clinical outcomes within a stable patient population with diabetes mellitus.

Research design and methods: We examined 1,275 stable patients with diabetes mellitus undergoing elective diagnostic coronary angiography with cardiac troponin I (cTnI) levels below the diagnostic cut-off for defining myocardial infarction (MI) (<0.03 ng/mL). The relationship of subclinical myocardial necrosis (cTnI 0.009-0.029 ng/mL) with incident major adverse cardiovascular events (MACE; defined as any death, MI, or stroke) over 3 years of follow-up was examined.

Results: Subclinical myocardial necrosis was observed in 22% of patients. A strong association was observed between the magnitude of subclinical myocardial necrosis and risk of 3-year incident MACE (hazard ratio, 1.98; 95% confidence interval, 1.48-2.65; P < 0.001) and remained statistically significant even after adjustment for traditional risk factors, high-sensitivity C-reactive protein, and creatinine clearance. Only a weak correlation was observed between the presence of subclinical myocardial necrosis and either glycemic control (r = 0.06; P = 0.044 for hemoglobin A1c versus cTnI) or insulin resistance (r = 0.04; P = 0.094 for glucose-to-insulin ratio versus cTnI).

Conclusions: The presence of detectable subclinical myocardial necrosis in stable patients with diabetes mellitus is associated with heightened long-term risk for MACE, independent of traditional risk factors and glycemic control.

Figures

Figure 1
Figure 1
Kaplan-Meier analysis for 3-year major adverse clinical events, stratified according to subclinical myocardial necrosis status (rounded to the nearest 0.001 ng/mL).
Figure 2
Figure 2
Cubic spline curve of HRs for major adverse clinical events at 3 years with cTnI levels.
Figure 3
Figure 3
Forest plot of risk prediction for major adverse clinical events at 3 years according to subclinical myocardial necrosis status stratified by HbA1c at cut-off of 6.5%.

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References

    1. Thygesen K, Alpert JS, White HD, et al. Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction Universal definition of myocardial infarction. Circulation 2007;116:2634–2653 - PubMed
    1. Francis GS, Tang WH. Cardiac troponins in renal insufficiency and other non-ischemic cardiac conditions. Prog Cardiovasc Dis 2004;47:196–206 - PubMed
    1. Omland T, de Lemos JA, Sabatine MS, et al. Prevention of Events with Angiotensin Converting Enzyme Inhibition (PEACE) Trial Investigators A sensitive cardiac troponin T assay in stable coronary artery disease. N Engl J Med 2009;361:2538–2547 - PMC - PubMed
    1. Tang WH, Wu Y, Nicholls SJ, et al. Subclinical myocardial necrosis and cardiovascular risk in stable patients undergoing elective cardiac evaluation. Arterioscler Thromb Vasc Biol 2010;30:634–640 - PMC - PubMed
    1. American Diabetes Association. Summary of revisions for the 2010 clinical practice recommendations. Diabetes Care 2010;33(Suppl 1):S3. - PMC - PubMed

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